Tucker O N, Heaton N
The Liver Transplant Unit, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
Curr Opin Crit Care. 2005 Apr;11(2):150-5. doi: 10.1097/01.ccx.0000157080.11117.45.
Small-for-size syndrome (SFSS) is a clinical syndrome described following liver transplantation (LT) and extended hepatectomy. New evidence has emerged documenting the importance of preoperative evaluation of functional liver mass, liver quality, influence of portal hypertension, and variations in surgical technique to improve outcome.
SFSS is characterized by postoperative coagulopathy and liver dysfunction due to insufficient functional liver mass. Recent radiologic advances allow accurate preoperative estimation of total, graft, and remnant liver volume (RLV). In adult-to-adult living donor liver transplantation (LDLT), a graft-to-recipient body weight ratio > or = 0.8% or graft weight ratio > or = 30% are important to avoid SFSS. Minimal functional RLV following extended hepatectomy is > or = 25% in a normal liver, and > or = 40% with preoperative liver dysfunction. Preoperative portal vein or hepatic artery embolization to increase RLV and function after extended hepatectomy, and the increasing use of parenchymal-sparing segmental resections have improved outcome. In LT, the evolving use of split livers, LDLT and marginal grafts has resulted in increased recognition of SFSS. This has led to a renewed interest in defining the pathophysiology, and the development of new surgical techniques to reduce its incidence.
Current radiologic imaging techniques can be used to evaluate liver volume and the risk of SFSS following LT and extended hepatectomy. Intraoperative techniques to predict postoperative dysfunction are emerging, and may be helpful in directing the use of pre-emptive surgical interventions. The future lies in the development of perioperative liver protection and support in predicted SFSS, and enhancement of healthy liver regeneration.
小肝综合征（SFSS）是一种在肝移植（LT）和扩大肝切除术后出现的临床综合征。新证据表明，术前评估功能性肝体积、肝脏质量、门静脉高压的影响以及手术技术的差异对于改善预后至关重要。
SFSS的特征是由于功能性肝体积不足导致术后凝血功能障碍和肝功能不全。近期放射学进展使得术前能够准确估计全肝、移植肝和残余肝体积（RLV）。在成人对成人活体肝移植（LDLT）中，移植物与受者体重比≥0.8%或移植物重量比≥30%对于避免SFSS很重要。扩大肝切除术后，正常肝脏的最小功能性RLV≥25%，术前存在肝功能障碍时则≥40%。术前门静脉或肝动脉栓塞以增加扩大肝切除术后的RLV和功能，以及实质保留性节段性肝切除术的日益应用改善了预后。在LT中，劈离式肝移植、LDLT和边缘性移植物的不断应用导致对SFSS的认识增加。这引发了对定义其病理生理学的新兴趣，并促使开发新的手术技术以降低其发生率。
当前的放射学成像技术可用于评估LT和扩大肝切除术后的肝体积及SFSS风险。预测术后功能障碍的术中技术正在兴起，可能有助于指导预防性手术干预的应用。未来在于开发针对预测的SFSS的围手术期肝脏保护和支持措施，以及促进健康肝脏再生。
